All was well in the first trimester.  Threw up a lot (until 25 weks), but otherwise fine.  But then I had my NT scan and started having tons of cramps afterward.  My ob put me on bedrest for 2 weeks.  I was allowed to go back to work afterward for 3 half days per week.  All was well for a month.  Then at 17 weeks, I started spotting.  Went to the ER against my better judgement (husband mae me all the after hours nurse and she wanted me to go in... sigh), and was diagnosed with a placenta previa.  Was put on bedrest again.  I spotted brown off and on for about 6 weeks.  At 24 weeks, I woke up bleeding.  I spent 3 days in the hospital and was finally allowed to go home, this time on strict bedrest.

At this point, I knew I was in trouble.  I'd been followed by the MFM since 6 weeks.  He didn't want me going past 38 weeks. But now I had a feeling I wouldn't even make it to 36.  With a heavy heart, I got out the preemie clothes. We had tried to not know if we were having a boy or girl, but the tech for our fetal echo was sloppy and I saw a scrotum.  We had fetal echocardiograms every 4 weeks due tot he risk of heart block Bradley had from my Sjogren's.  I never left my bedroom, except to go to my doctor's appointments.  And then at 26 weeks, I bled again in the middle of the night.  Again, I didn't want to go in, but my husband and the after hours nurse made me.  I went to the hospital I thought I was delivering at, which was 5 minutes from our home.  I was admitted for observation, started on magnesium (again), and this time given a steroid window.  When my doctor saw me later in the day, he said that I needed a higher level of care and was transferring me to a hospital with a level 3 NICU (we were at a level 2EQ).  So, to my embarrassment, I was transported by ambulance.  As a resident, I hated transports, and now I was one! The new hospital was about 12-15 minutes from the house. I was grouchy because the doctor told me I'd be there for the duration of my pregnancy.  I got settled in my room and woke up around 6am literally gushing blood.

I called my husband, who seemed to instantaneously appear, even after having dropped our son off at a friend's.  I was rushed from antepartum to L&D.  Fortunately, Bradley behaved himself and my bleeding slowed down.  My stepdad even drove up from out of town because he was worried.  From that point, I never argued about staying in the hospital.  I tried to be patient and just let things roll.  I bled off and on and did crafts.  My husband and 3 year old visited 1-2 times a day (my husband is a stay at home dad), which kept my spirits up.  I had few other visitors, which suited me fine, as they stressed me out.  No one understood that I had to be there.  That Bradley or I might die waiting fro an ambulance at home if the blood came again.  That Bradley might be brain damaged if such a thing happened. That Bradley might die. I watched a lot of trash tv on Netflix.  Lots of movies.  I continued to crochet and cross stich little bibs.



My ob actually came out of his uber-conservative shell and was going to let me go back home after having a steroid booster.  So I got one shot on Friday afternoon.  That evening, my boss from work came by, which was nice.  No one was with me because it was expected I'd come home the next evening, so the company was appreciated.  Well, I went to sleep.  Woke upi around 6am 9/22 to the feeling of gushing blood and was rushed to L&D.  My husband arrived eerily fast once again.  This time my mother-in-law had come to help out, so no arrangements for childcare had to be made.  Well, the bleeding slowed, but didn't stop.  I was 4cm, laboring.  Bradley looked wonderful on the monitor, so I labored. I got my epidural right away-- I've never had any illusions about my pain tolerance.  I feel epidurals were a marvelous invention, but if you feel the need for pain just because cave women did it that way, so be it.  So I got the epidural and my contractions slowed down.  I was 6cm for hours.  They broke my water, and still no change.  Pitocin was started and about 30 minutes later, I was in excruciating pain and needed to push.  My epidural, it seemed, was not working.  At all.  My doctor was not on call.  His backup was at her house.  The hospitalist was moseying along or something because she did not arrive instantaneously like I wanted.  She got her gown and gloves on ever so slowly.  I pushed and I knew exactly what my patients meant when they said they couldn't push.  I felt paralyzed by pain.  Next contraction came.  I pushed.  Then I cried and somehow he was born in about 4-5 minutes of pushing.  Thank God for that.  He was born at 11:53pm on 9/22.  7 minutes before I turned 34.  My best birthday present ever.

He was beautiful.  My first words were, "He's so big!" Maybe he wasn't to parents of termies, but he was to me.  The hospitalist (who later turned out to be my new boss's wife... weird...) put him on my chest and I held him.  I cut his cord (I also cut Alec's as Colin refused) and they whisked him to the isolette in the room.  A moment later I heard him cry.  I kept on crying.  It was a beautiful sound.  His APGAR's wre 8 and 9, so they brought him to me to hold before they took him to the NICU.  I just couldn't get over how beautiful he was.

I ventured over to the NICU after I pumped a second time and showered.  My plan was to pump every 2 hours from 6am until 6pm and then every 3 hours from 6pm to 6am.  People thought I was crazy, but my milk came in quickly.  We got ribs and a cake for my birthday, which was obviously spent in the hospital.  Unfortunately  that night, the nurse called and said bradley's IV had infiltrated his TPN into his little hand and caused a chemical burn.  The whole back of his hand was black and there was an ulcerated area in the center.  It ended up taking about 5 weeks to heal.

Other than the IV issue, Bradley was our little rock star.  He never did end up needing oxygen support or other medications.  He started oral feeds on either 9/23 or 9/24.  Those dates get a little blurry.  He was jaundiced and had a hard time passing his meconium, but was otherwise amazing.  He was on full oral feeds by day 10 of life and was moved from the NICU to the CCN (continuing care nursery, a step-down unit).  Gone was our private oasis and amazing nurse. We were in a 4-bed room with new nurses to get used to.  On day 2 of being in the CCN, we got to try the bottle.  he ate like a champ.  We brought in our own bottles from home, which they happily used.  I was determined to breastfeed and didn't want even their "slow" flow nipples.  I had been doing the non-nutritive breastfeeding, and Bradley had taken to it.  The day after his bottle feed, I got to breastfeed him!  He was amazing.

It was around this time, maybe a few days earlier, that my nipples started their issues.  My old pump in style was not functioning properly and the suction was out of control.  I think that may have had something to do with it.  I likely started out with too small flanges, which contributed to it.  And I was pumping tons from the get go.  My areolas were raw.  I tried every remedy imaginable.  Maybe thrush, so I used gentian violet.  I had 2 strengths of APNO.  I had lansinoh.  I used warm saline soaks.  I air dried.  I spead milk on them.  I used ice.  Nothing.  Finally, my lactation consult in the NICU (God bless her) as well as an IBCLC friend who runs a physicians breastfeeding support group suggested nifedipine.  They thought I might have traumatic Raynaud's of the nipple.  I was also told to use the giant 36mm flanges and the APNO round the clock.  Within 3 or 4 days, my nipples were healed. 

Then latch issues started after we got home.  In the hospital, Bradley was a great nurser.  But once we were home, he started hurting and he nursed constantly.  On my parenting board online someone suggested tongue tie.  I looked at some pictures on Google and then in my sweet boy's mouth and wow! His tongue tie went all the way to the tip of his tongue! Not sure why no one in the NICU noticed this since he was examined daily.  He also had a very thick lip tie.  I have since learned these are common in families, as well as in preemies.  Alec didn't have this and no one in either family did, so we can thank preemiehood.  Luckliy my IBCLC friend took one look at my pictures and referred me to a pediatrician who cauterized tongue and lip ties.  The tongue was done first, and I was discouraged because nothing changed.  I wondered if because Bradley was 3 months old that he had developed bad habits we would have to correct.  2 weeks later the lip tie was done.  Once the cauterized area healed, it was amazing! No pain!  My husband reported that he had stopped screaming all day.  And his need to constantly nurse stopped, as he was better able to extract the milk. 

Since then, it's been mostly smooth sailing.  Bradley did have a largeish umbilical hernia, which I freaked out about.  I was so worried he'd need surgery, but the pediatrician said they normally just observe them, and it's so small it never pokes out anymore.  He does have the worst case of eczema my pediatrician has ever seen, and that is a constant struggle for us, but we keep it in check with steroid creams and super thick lotions.  My beautiful baby boy is now 14lb and 26in long.  His length is average size for a 6 month old and in greater than the 99th percentile for 4 month olds.  Crazy!

During my pregnancy, I never could have gotten through without 2 groups.  The first group are the lovely ladies on the high risk, preemie, and birth month boards on thebump.com. They are amazing, supportive, and knowledgeable-- even for non medical people!  I checked in multiple times a day every day for months.  It was nice to know others were going through almost exactly the same thing as me!

The second group is sidelines.org.  This is a specific support group for pregnant women on bedrest.  They were a godsend.  They assign you a buddy who can either call and e-mail you or just e-mail you.  You chat back and forth and you don't feel so socially isolated and alone.  I plan on volunteering as soon as I finish my class-- I am starting to get my CME's and experience together to get my IBCLC.

I also used an organization called Pictures of Hope.  They're a fantastic, non profit organization where photographers in the community come to your NICU and take professional pictures of your baby.  The sitting is free.  You also get 25 4x6 prints, as well as a discount (determined by the photographer) on any additional prints you get.  Our photographer drove 60+ miles from Queen Creek to Glendale to take Bradley's picture.  She was wonderful.  Many of the photographers are preemie moms too, so they really get it!  There is a list of photographers on their website.

During Prematurity Awareness Month (November), I put one fact about prematurity on my Facebook page every day.  My friends and family commented about what they learned and how shocked they were at what we went through almost every day.  It was nice that they could finally understand what I meant by "adjusted age" and stuff like the challenges preemies face.  There are Facebook groups for Prematurity Awareness Month, Parents of Preemies, Preemie Dads, and Preemie Resources.  I'd recommend joining any or all of these groups.

I am also doing the March of Dimes March for Babies to raise money and awareness for prematurity and high risk pregnancy.  It's amazing how many friends of friends have gone through a premature birth or difficult pregnancy and no one knew!  So I'm marching with my friend's friend's team.  Her 28 weeker is now 8 years old.  She has many of the same NICU pictures I do.  I am sure everyone else has these too.

I also participated in a study for the Organization for Teratology Information Services (OTIS).  Basically OTIS monitors women who have drug exposures in pregnancy.  You sign up for a particular study and then you track your medications, hospitalizations, and ultrasounds.  I was in the rheumatoid arthritis study, the asthma study, and the vaccination study.  They did follow up interviews throughout the pregnancy and a developmental pediatrician came out to examine Bradley about a month ago.  He did some special measurements and was really pleased at how he was developing.  That made me feel great.

We are also followed by the Neonatal Intensive Care Program (NICP) here in AZ.  The nurse comes out and does home visits for 18 months + to monitor the preemies' development and can facilitate entry into the early intervention system if needed.  NICP is paid for by the state, as is early intervention.  So, if we need speech, occupational, physical therapy or perhaps a dietician, she can make all that happen.  She encouraged us to apply for WIC (I qualified... a doctor! Love that short term disability only paying me 27% of my salary...) and social security, which paid for gas going to and from the hospital while Bradley was there.  She also talked to us about deferring my student loans and credit card bills until we got back on our feet. 

As an ob/gyn, I never knew about any of this.  I basically came into this situation blind.  I'd delivered many a preemie and put many a woman on hospital or home bedrest without thinking of the consequences of that.  Now I really think of how that affects a mom and baby and family and I weigh all of my decisions carefully.  I am a much more sympathetic and empathetic doctor.  It was shocking to me all of the things that went along with it.  Sure, we followed up on our preemie deliveries to see how they were doing, but we never got to see the human side of our actions.  Having lived through it now has taught me a lot.  Strangely, I am grateful for my experiences.  I do want another baby, but we have agreed that Bradley is our last.  We came through this experience as a family, but again, I have the guilt of "abandoning" my husband and 3 year old.  Alec was great-- he enjoyed going to the "hostible" and seeing me or spending time on my sister-in-law's farm.  It was a fun time for him.  It was agonizing for me to miss out on our lives.  I also feel like we dodged a bullet.  Twice.  We got lucky that we had no major complications with either of our sons, and we don't want to tempt fate.  If we do, will be get a 28 weeker this time? A 24 weeker this time? IVH? ROP? NEC? Death of me or the baby? It's not worth it.  I love my family too much to put them through all that again.

When I found out I was pregnant I knew I wanted to breastfeed. The thought of feeding my child any other way never crossed my mind. I even had conversations with a few friends who were also pregnant at the time. They had mentioned their desire to breastfeed as well but also their fear that it just wouldn't work out. That thought never crossed my mind.

While this is a story about my success with breastfeeding a preemie I need to start with sharing a bit of Isaac's birth story with you. My pregnancy was going great. Until the last trimester. Enter high blood pressure, pre-eclampisa and bed rest. Add in a baby that quit growing and you have a 3 pound 4.5 ounce baby born at 35 weeks.

I had a few strikes against me right from the start. First of all, I had to have a c-section. I had no labor at all. The combination of having Isaac early and the c-section confused my body. I mean I was still suppose to be pregnant after all. My body didn't know right away that I had had a baby.

Before Isaac was born they told me if things looked okay we'd be able to try and breastfeed and do skin to skin within the first hour after he was born. Unfortunately he was having problems breathing in his own. So there was no way we could try breastfeeding or do skin to skin. Enter strike two.

Strike three is probably the hardest of them all. Isaac needed a NICU. The hospital we were at didn't have one. So he had to be airlifted to a NICU 1.5 hours away.  I didn't see him for three days.

I started pumping within an hour of Isaac's birth. I continued to pump every 2 hours during the day and every 3-4 hour at night. For the first two days it was all about signaling the body that it was time to produce milk. I didn't get anything from pumping except a few drops every once it awhile. It was very discouraging. At one point I got about half an ounce and I wanted to jump for joy. By the time I was released from the hospital I was probably producing less than an ounce a day. Whatever I managed to get with pumping I would save for Isaac. Pumping was extremely hard to do simply because there was no emotional connection. I was able to hold Isaac once before he was airlifted. Not being able to see my child made things extremely hard. Looking at pictures helped. But it was still hard.

When Isaac and I were reunited it was still to soon for him to try nursing. He was still really little and slept a majority of the time. So I continued to pump. The NICU had a room with a pump so I was able to stay at the hospital as much as possible. We tried to do skin to skin when we could and finally when Isaac was a week old I met with the lactation consultant, LC, for the first time. She helped me with getting him latched and told me what cues and signals that I needed to look for ensure he was sucking and swallowing. I was watching for raised eyebrows and ear wiggles. That's how I knew Isaac was swallowing.

Once we started nursing I wanted to do it all the time but I couldn't. Isaac was still really little and still slept a ton. Nursing was something that really pooped him out. He rarely ever cued that he was hungry so it really was all about going through the motions. Once Isaac was nursing successful with one feeding we increased it to two. We continued to increase the feedings when he did well. It didn't always go well though and it was emotionally draining on those days. Somedays he'd show no interest in nursing at all. Sometimes he'd get latched on but wouldn't do anything but sit there and he wouldn't eat. When he did nurse he's eat for a few minutes and then fall asleep. We kept working at it though and I met with the LC many times. I continued to pump the same amount I was before. Every 2 hours during the day and every 3-4 hours at night. When Isaac nursed I'd pump afterwards. 

I'll be honest. Nursing in the NICU kinda sucks. We were put on schedules of when I had to try nursing. Typically they were always on the hour but they wanted me there 30 minutes before just in case Isaac was wanting to eat before. If they wanted me to try nursing at 8am they wanted me there at 7:30 just in case. He had to be awake to eat and sometimes he'd be sleepy. Sometimes he wouldn't wake up, even when we tried to wake him. After every time he was awake and nursed they'd ask me how it went. They'd ask me if I thought he ate enough and if I thought he needed more. I was a first time mom. I had no idea. There was so much pressure. Most of the time they'd give Isaac more milk through a feeding tube. When we were first trying to teach him to nurse they usually give him a few tube feeds in between our nursing sessions. I really just wanted to feed him on demand. I wanted to feed him when he was showing signs of hunger, but it can't be done that way. Not when you have a tiny baby on your hands.

Isaac was released when we were able to successfully nurse a full day. They took his feeding tube out and we (my husband and I) roomed in with Isaac. He was released the next day. Isaac and I continued struggle at home with latching on and the length of nursing but we weren't bound by schedules so it made things a lot easier. When Isaac came home the LC told me to keep up with the pumping after every feeding and then drop a pumping session every few days. I am not sure why they wanted me to do this but as a first time mom I listened. It created an oversupply issue which made nursing even more challenging. I was almost always engorged which would often cause milk to get everywhere whenever Isaac would try to nurse. I did some research and spoke with the LC who told me to stop pumping and then try block feeding. I had to nurse from one side for several hours while leaving the other side alone. Then after 2-3 feedings I nursed from the other side. It was an extremely painful process. But it was corrected after a few days.  

Isaac is almost five months old and we still need to use the cross cradle hold because he still needs my support with his head. Sometimes we are able to do the cradle hold but not very often.  A majority of the time he is able to get latched on right away with no issues but it took a long time for us to get to that point. His nursing sessions are never very long. Usually only 10-15 minutes. Sometimes a little longer. And he rarely nurses from both sides. At first I was concerned, especially in the NICU because all the classes and books say 15-20 minutes on one side and 10-15 on the other side. But he was always getting enough. I guess the books and classes are wrong sometimes. It was a long process and there were so many times I wanted throw in the towel. It was really hard but I just couldn't allow myself to do that. Now I look back at everything we went through and I am so proud that we managed to beat every obstacle that came before us. 

Don't give up! Just keep working at it! You won't regret it!